|
Multiple Vitamins Tab
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77716317
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
Multiple Vitamins Tab
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
77716317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Medicaid |
$5.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.76
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Parkland Medicaid |
$5.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.76
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
Multivitamin with minerals (Renal Vit)
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
79911429
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$5.44
|
|
|
Multivitamin with minerals (Renal Vit)
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
79911429
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$0.72
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2.40
|
| Rate for Payer: BCBS of TX Blue Essentials |
$2.88
|
| Rate for Payer: BCBS of TX PPO |
$3.20
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Medicaid |
$5.76
|
| Rate for Payer: Molina CHIP/Medicaid |
$5.76
|
| Rate for Payer: Multiplan Auto |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Multiplan Workers Comp |
$5.20
|
| Rate for Payer: Parkland Medicaid |
$5.76
|
| Rate for Payer: Scott and White EPO/PPO |
$4.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5.76
|
| Rate for Payer: Superior Health Plan EPO |
$1.09
|
|
|
Mumps Antibodies, IgG SO
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
1705557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$5.09
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: BCBS of TX Blue Advantage |
$49.20
|
| Rate for Payer: BCBS of TX Blue Essentials |
$59.04
|
| Rate for Payer: BCBS of TX Medicare |
$13.05
|
| Rate for Payer: BCBS of TX PPO |
$65.60
|
| Rate for Payer: Cash Price |
$111.52
|
| Rate for Payer: Cash Price |
$111.52
|
| Rate for Payer: Cigna Medicaid |
$118.08
|
| Rate for Payer: Cigna Medicare |
$13.05
|
| Rate for Payer: Employer Direct Commercial |
$13.05
|
| Rate for Payer: Humana Medicare/TRICARE |
$13.05
|
| Rate for Payer: Molina CHIP/Medicaid |
$118.08
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Molina Medicare |
$13.05
|
| Rate for Payer: Multiplan Auto |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$106.60
|
| Rate for Payer: Multiplan Workers Comp |
$106.60
|
| Rate for Payer: Parkland Medicaid |
$118.08
|
| Rate for Payer: Scott and White EPO/PPO |
$16.31
|
| Rate for Payer: Scott and White Medicare |
$13.05
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$118.08
|
| Rate for Payer: Superior Health Plan EPO |
$13.05
|
| Rate for Payer: Superior Health Plan Medicare |
$13.05
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$13.05
|
| Rate for Payer: Universal American Medicare |
$13.05
|
| Rate for Payer: Wellcare Medicare |
$13.05
|
| Rate for Payer: Wellmed Medicare |
$13.05
|
|
|
Mumps Antibodies, IgG SO
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
1705557
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$111.52
|
|
|
mupirocin topical 2% Ointment
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78432468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.44
|
| Rate for Payer: BCBS of TX Blue Advantage |
$34.80
|
| Rate for Payer: BCBS of TX Blue Essentials |
$41.76
|
| Rate for Payer: BCBS of TX PPO |
$46.40
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cigna Medicaid |
$83.52
|
| Rate for Payer: Molina CHIP/Medicaid |
$83.52
|
| Rate for Payer: Multiplan Auto |
$75.40
|
| Rate for Payer: Multiplan Commercial |
$75.40
|
| Rate for Payer: Multiplan Workers Comp |
$75.40
|
| Rate for Payer: Parkland Medicaid |
$83.52
|
| Rate for Payer: Scott and White EPO/PPO |
$58.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$83.52
|
| Rate for Payer: Superior Health Plan EPO |
$15.78
|
|
|
mupirocin topical 2% Ointment
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
78432468
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$78.88
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap head and neck with named vascular pedicle (ie, buccin
|
Facility
|
OP
|
$10,566.45
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
9900132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cash Price |
$7,185.19
|
| Rate for Payer: Cash Price |
$7,185.19
|
| Rate for Payer: Cash Price |
$7,185.19
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicaid |
$7,607.84
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,607.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$7,607.84
|
| Rate for Payer: Scott and White EPO/PPO |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,607.84
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap head and neck with named vascular pedicle (ie, buccin
|
Facility
|
IP
|
$10,566.45
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
9900132
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,185.19
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap head and neck with named vascular pedicle (ie, buccin
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15733
|
| Hospital Charge Code |
36015733
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap; lower extremity
|
Facility
|
OP
|
$13,673.04
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
990928
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cash Price |
$9,297.67
|
| Rate for Payer: Cash Price |
$9,297.67
|
| Rate for Payer: Cash Price |
$9,297.67
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicaid |
$9,844.59
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$9,844.59
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$9,844.59
|
| Rate for Payer: Scott and White EPO/PPO |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$9,844.59
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap; lower extremity
|
Facility
|
IP
|
$13,673.04
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
990928
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,297.67
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap; trunk
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
36015734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap; trunk
|
Facility
|
IP
|
$10,566.45
|
|
|
Service Code
|
HCPCS 15734
|
| Hospital Charge Code |
9900133
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,185.19
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap; trunk
|
Facility
|
OP
|
$10,566.45
|
|
|
Service Code
|
HCPCS 15734
|
| Hospital Charge Code |
9900133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.62 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,457.62
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Amerigroup Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,972.07
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,954.58
|
| Rate for Payer: BCBS of TX Medicare |
$3,559.87
|
| Rate for Payer: BCBS of TX PPO |
$7,502.77
|
| Rate for Payer: Cash Price |
$7,185.19
|
| Rate for Payer: Cash Price |
$7,185.19
|
| Rate for Payer: Cash Price |
$7,185.19
|
| Rate for Payer: Cigna Commercial |
$7,524.93
|
| Rate for Payer: Cigna Medicaid |
$7,607.84
|
| Rate for Payer: Cigna Medicare |
$3,559.87
|
| Rate for Payer: Employer Direct Commercial |
$3,559.87
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,559.87
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,607.84
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Molina Medicare |
$3,559.87
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$7,607.84
|
| Rate for Payer: Scott and White EPO/PPO |
$6,069.94
|
| Rate for Payer: Scott and White Medicare |
$3,559.87
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,607.84
|
| Rate for Payer: Superior Health Plan EPO |
$3,559.87
|
| Rate for Payer: Superior Health Plan Medicare |
$3,559.87
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,559.87
|
| Rate for Payer: Universal American Medicare |
$3,559.87
|
| Rate for Payer: Wellcare Medicare |
$3,559.87
|
| Rate for Payer: Wellmed Medicare |
$3,559.87
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap upper extremity
|
Facility
|
OP
|
$10,292.16
|
|
|
Service Code
|
HCPCS 15736
|
| Hospital Charge Code |
9900134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cash Price |
$6,998.67
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicaid |
$7,410.36
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina CHIP/Medicaid |
$7,410.36
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$7,410.36
|
| Rate for Payer: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$7,410.36
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap upper extremity
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 15736
|
| Hospital Charge Code |
36015736
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.01 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$709.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Amerigroup Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX Blue Advantage |
$2,709.98
|
| Rate for Payer: BCBS of TX Blue Essentials |
$3,245.48
|
| Rate for Payer: BCBS of TX Medicare |
$2,072.68
|
| Rate for Payer: BCBS of TX PPO |
$4,089.30
|
| Rate for Payer: Cigna Commercial |
$4,381.27
|
| Rate for Payer: Cigna Medicare |
$2,072.68
|
| Rate for Payer: Employer Direct Commercial |
$2,072.68
|
| Rate for Payer: Humana Medicare/TRICARE |
$2,072.68
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Molina Medicare |
$2,072.68
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$3,085.41
|
| Rate for Payer: Scott and White Medicare |
$2,072.68
|
| Rate for Payer: Superior Health Plan EPO |
$2,072.68
|
| Rate for Payer: Superior Health Plan Medicare |
$2,072.68
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$2,072.68
|
| Rate for Payer: Universal American Medicare |
$2,072.68
|
| Rate for Payer: Wellcare Medicare |
$2,072.68
|
| Rate for Payer: Wellmed Medicare |
$2,072.68
|
|
|
Muscle, myocutaneous, or fasciocutaneous flap upper extremity
|
Facility
|
IP
|
$10,292.16
|
|
|
Service Code
|
HCPCS 15736
|
| Hospital Charge Code |
9900134
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,998.67
|
|
|
Muscle transfer, any type, shoulder or upper arm single
|
Facility
|
IP
|
$21,784.26
|
|
|
Service Code
|
HCPCS 23395
|
| Hospital Charge Code |
9900220
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,813.30
|
|
|
Muscle transfer, any type, shoulder or upper arm single
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 23395
|
| Hospital Charge Code |
36023395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Muscle transfer, any type, shoulder or upper arm single
|
Facility
|
OP
|
$21,784.26
|
|
|
Service Code
|
HCPCS 23395
|
| Hospital Charge Code |
9900220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,684.67 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$14,813.30
|
| Rate for Payer: Cash Price |
$14,813.30
|
| Rate for Payer: Cash Price |
$14,813.30
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$15,684.67
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,684.67
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$15,684.67
|
| Rate for Payer: Scott and White EPO/PPO |
$12,104.03
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$15,684.67
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$16,838.09
|
|
|
Service Code
|
APR-DRG 9123
|
| Min. Negotiated Rate |
$15,875.54 |
| Max. Negotiated Rate |
$16,838.09 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$15,875.54
|
| Rate for Payer: Cigna Medicaid |
$15,875.54
|
| Rate for Payer: Molina CHIP/Medicaid |
$15,875.54
|
| Rate for Payer: Parkland Medicaid |
$15,875.54
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$16,838.09
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$11,056.54
|
|
|
Service Code
|
APR-DRG 9122
|
| Min. Negotiated Rate |
$10,424.49 |
| Max. Negotiated Rate |
$11,056.54 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10,424.49
|
| Rate for Payer: Cigna Medicaid |
$10,424.49
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,424.49
|
| Rate for Payer: Parkland Medicaid |
$10,424.49
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11,056.54
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$37,316.82
|
|
|
Service Code
|
APR-DRG 9124
|
| Min. Negotiated Rate |
$35,183.60 |
| Max. Negotiated Rate |
$37,316.82 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$35,183.60
|
| Rate for Payer: Cigna Medicaid |
$35,183.60
|
| Rate for Payer: Molina CHIP/Medicaid |
$35,183.60
|
| Rate for Payer: Parkland Medicaid |
$35,183.60
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$37,316.82
|
|
